Homeless Deaths in in Santa Cla lara County, CA A Retrospective Study 2011-2016 Kari arin Wells ls, BA, , Stu Student In Intern for or the Chie Chief Medic ical l Ex Examiner Mic ichelle A. . Jor Jorden, , MD, , Ch Chie ief Medical Ex Examiner Sa Santa Clar Clara Co County Medical Ex Examiner- Coroner’s Office
METHOD AND PROJECT OUTLINE • Each year, from 2011 through 2016, was analyzed for • Demographics • Cause and manner of death • Location of death • Medical history • Drug use • Veteran status • Motor vehicle related deaths • Each case file was reviewed, number of deaths verified, and variables analyzed by the Chief Medical Examiner Michelle A. Jorden, MD, Interim Chief Investigator Rosa Vega, and student intern Karin Wells
HOMELESSNESS • The Medical Examiner- Coroner’s Office determine homelessness if the circumstances of the death occurred in an environment to suggest homelessness (e.g. homeless encampment) or the decedent was known to be homeless and/or public record searches do not identify a valid living address
TOTAL HOMELESS DEATHS 2011-2016 HOMELESS DEATHS IN SANTA CLARA COUNTY 2011-2016 140 120 NUMBER OF DECEDENTS 100 80 60 40 20 0 2011 2012 2013 2014 2015 2016 YEAR • There were 50 homeless deaths in Santa Clara County in 2011, followed by 62 in 2012, 78 in 2013, 69 in 2014, 85 in 2015, and 132 in 2016. • Between 2011 and 2016, the number of homeless deaths increased by 164%.
DEMOGRAPHICS: SEX SEX Female 17% Male 83% Male Female
DEMOGRAPHICS: ETHNICITY ETHNICITY Caucasian 1% 0% 1% Hispanic 0% 1% 1% 4% Black 8% Asian Pacific Islander Native American East Indian 26% 58% Middle Eastern Other Unknown
DEMOGRAPHICS: AGE AGE AT DEATH Year Age (in years) 2011 53 2012 47, 55, 57 2013 46, 49, 52 2014 58 2015 53 2016 62 • There were two fetal demises during the six year period.
LOCATION OF DEATH LOCATION OF DEATH 2011-2016 180 160 140 NUMBER OF DECEDENTS 120 100 80 60 40 20 0 Indoor Makeshift Living Outdoor Makeshift Outdoors (not living Hospital/ER/Nursing Indoors (other) Hotel/Motel Other Residence Homeless Shelters Area Living Area there) Facility LOCATION
THE AGING HOMELESS POPULATION DECEDENTS 65 AND OVER 2011-2016 25 20 NUMBER OF DECEDENTS 15 10 5 0 2011 2012 2013 2014 2015 2016 YEAR
MANNER OF DEATH MANNER OF DEATH 2011-2016 250 200 NUMBER OF DECEDENTS 150 100 50 0 Natural Accident Undetermined Suicide Homicide Pending MANNER
TOTAL DEATHS PER SEASON DEATHS PER SEASON 2011-2016 Winter Spring Summer Fall 140 120 100 NUMBER OF DECEDENTS 80 60 40 20 0 2011 2012 2013 2014 2015 2016 YEAR
HOMELESS VETERANS VETERANS 2011-2016 10 9 8 7 NUMBER OF DECEDENTS 6 5 4 3 2 1 0 2011 2012 2013 2014 2015 2016 YEAR
CAUSES OF DEATH: VEHICLE ACCIDENTS VEHICLE ACCIDENTS AS CAUSE OF DEATH 2011-2016 14 12 10 NUMBER OF DECEDENTS 8 6 4 2 0 2011 2012 2013 2014 2015 2016 YEAR
CAUSES OF DEATH: DRUGS AND ALCOHOL CAUSE OF DEATH DUE TO DRUG/ALCOHOL INTOXICATION 2011-2016 30 25 NUMBER OF DECEDENTS 20 15 10 5 0 2011 2012 2013 2014 2015 2016 YEAR
PRESENCE OF METHAMPHETAMINE AND ALCOHOL 45 40 35 NUMBER OF DECEDENTS 30 25 20 15 10 5 0 2011 2012 2013 2014 2015 2016 YEAR Alcohol Methamphetamine
MENTAL ILLNESS MENTAL ILLNESS 2011-2016 25 NUMBER OF DECEDENTS WITH A MENTAL ILLNESS 20 15 10 5 0 2011 2012 2013 2014 2015 2016 YEAR
STRESSORS PRIOR TO DEATH RECENT STRESSORS Emotional Medical Altercations (physical and verbal) Law Enforcement 30 25 NUMBER OF DECEDENTS 20 15 10 5 0 2011 2012 2013 2014 2015 2016 YEAR
HIGHLIGHTS • The number of homeless deaths in Santa Clara County increased 164% over the six year period. Between 2011 and 2016, the homeless population rose, with the greatest number of deaths occurring in 2016. • Homeless deaths were more common among males than females, with Caucasians being the most predominantly represented ethnic group. • Alcohol and drug abuse continues to claim a significant number of homeless deaths each year with alcohol and methamphetamine being the most commonly abused drugs. Heroin deaths are being monitored given the opioid epidemic. • The number of elderly deaths over the age of 65 years has risen and is expected to rise given the aging baby boomer population. • A significant percentage of the homeless are continuing to die in homeless encampments and on the streets with zip codes 95128 and 95116 being the hot spots currently identified for these deaths.
RECOMMENDATIONS • Homelessness is a complex and multifactorial social issue as exemplified in this study. Access to consistent medical and mental health care services, as well as drug and alcohol services and employment resources are underscored. • The combination of drug and alcohol intoxication was shown to be the most prevalent lethal factor over the entire study period. Ensuring that the homeless population has consistent access to drug and alcohol intervention services is warranted. • The current opioid epidemic can affect the homeless population including access to synthetic opioids. The distribution and use of Narcan (naloxone) should be considered in this population to prevent overdoses. • With an increase of baby boomers becoming older, preventive healthcare in the form of vaccines (pneumonia/shingles), as well as treating chronic medical conditions such as hypertension and diabetes is underscored for this population. • The homeless population, like anyone, may be involved in relationships with others or pets that cannot be easily separated or accommodated in shelters or other facilities. We must remember and be sensitive to these, as well as transgender and LGBTQ issues that may affect this population.
ACKNOWLEDGEMENTS Deputy Public Defender Andrew Gutierrez County of Santa Clara Interim Chief Medical Examiner-Coroner Investigator Rosa Vega Santa Clara County Medical Examiner- Coroner’s Office
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